Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide Nursing assessment for soft tissue injuries and fractures: • Check vital signs, especially blood pressure, for signs of shock(hypotension) • Assess respiratory status and circulatory status if bleeding orbruising • Inquire about how injury happened and the time since occurrence o An important note about types of injuries: Fractures in children need to be assessed for suspected abuse. Take a thorough history from caregivers, but carefully evaluate the injuries for the following signs:  Struck by car: Most common are trunk injuries, femur fractures, and head injury  Using arms to break falls: Most common are injuries to the forearm, finger, clavicle, elbow, wrist, and shoulder  Infant abuse (under one year): Most common are tibia/fibula fractures, metaphyseal humerus fractures, mid-shaft, femur, and radius/ulna fractures • Assess pain level, location, and nature of pain • Immobilize injured area until physician can perform a full exam Nursing interventions for soft tissue injuries and fractures: • R.I.C.E. is used for the first 24 hours after the injury (rest, ice, compression,and elevation) • Use care with transfers; keep the body aligned, especially the injured body part • Prepare patient for repair of injury: o Open reduction : An orthopedic surgeon will repair the alignment in surgery. o Closed reduction: The broken bone is manipulated through the skin. o External fixation : The broken bone is placed in a cast or splint until the bone heals. Pins might be inserted into the bone from outside (Hoffman Device). Ensure good skin care to avoid breakdown. If pins are used, give frequent wound care to prevent infection. o Internal fixation: Orthopedic surgeons surgically repair the bone with screws, nails, plates, and pins. o Skin traction: Non-invasive devices are attached to the extremity. The use of weights, pulleys, and ropes are used to realign the fractured bones. Use caution when working with straps to always keep the same traction on the affected limb. Always make sure wraps are not too tight or loose and ask for help when working with equipment. o Skeletal traction: The orthopedic surgeon places pins into the bone during surgery. Ropes, pulleys, and weights are used like skin traction, only it is connected inside the body. For this reason, skin care must be performed often. o Open reduction with internal fixation: These two are used together often to repair a hip fracture. The site is opened surgically, the bone realigned, and then pins or plates used in the repair. • Keep affected part elevated as much as possible • Provide a trapeze over the bed for positioning

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